Delivering Healthcare Services to the American Home

Author: Philip E. Auerswald


The coronavirus pandemic has forced a sudden acceleration of a prior trend toward the virtual provision of healthcare, also known as telemedicine. This acceleration was necessary in the short term so that provision of non-urgent health services could continue despite lockdowns and self-isolation. Federal and state policymakers have supported the shift toward telemedicine through temporary adjustments to health benefits, reimbursements, and licensure restrictions.

Yet if policymakers direct their attention too narrowly on expanding telemedicine they risk missing a larger—and as yet mostly unrealized—opportunity to improve healthcare in the United States: increasing the overall share of health services provided directly to the home. At-home healthcare includes not only telemedicine, but also medical house calls (home-based primary care) as well as models in which individuals within communities offer simple support services to one another (i.e., the “village” model of senior care, which could be extended to included peer-to-peer health service delivery). The advent of “exponential” technologies such as artificial intelligence (AI), blockchain, and the Internet of Things (IoT) is unlocking new possibilities for at-home healthcare across each of these models.

The Biden-Harris Administration should act to reduce four types of barriers currently preventing at-home healthcare from reaching its full potential:

  1. Labor-market barriers (e.g., unnecessarily restrictive scope-of-practice rules and requirements for licensing and certification)

  2. Technical barriers (e.g., excessively slow and burdensome processes for regulatory approval, weak or absent standards for interoperability)

  3. Financial/regulatory barriers (e.g., methodologies for determining eligibility for reimbursements that favor incumbents over innovators)

  4. Data sharing / interoperability barriers (e.g., overly restrictive constraints related to data privacy and portability)

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About the Author

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Philip Auerswald is the founding board chair and president of the National Center for Entrepreneurship and Innovation and an associate professor of public policy at George Mason University. Auerswald has published over fifty books, peer-reviewed articles, book chapters and professional reports on entrepreneurship, innovation, and public policy. He is most recently the author of The Code Economy: A Forty-Thousand-Year History (Oxford University Press, 2017) and The Coming Prosperity: How Entrepreneurs Are Transforming the Global Economy (Oxford University Press, 2012). He has blogged and written op-eds for The New York Times, Harvard Business Review, Forbes, The International Herald Tribune, and The San Francisco Chronicle, among other outlets. Prior to joining the faculty at George Mason University, Professor Auerswald was a lecturer and assistant director of the Science, Technology, and Public Policy Program at the Kennedy School of Government, Harvard University. The author acknowledges support for this work from the Mercatus Center, George Mason University.